Outpatient Growth Must Keep Pace with Population

"Outpatient to us doesn't mean just bricks and mortar; that's a component of it, and being in the right place with a new kind of array of services—Convenient Care Centers," he says. "But the management of any of those populations has to be married up to a care delivery network of primary care physicians that need to be organized in different ways, too, which is around patient-centered medical homes."

MHMD's 3,900 physician members include more than 2,000 who participate in its clinical integration program; more than 1,700 specialists, and more than 500 primary care physicians. But Houston's physicians mirror a Texas trend of doctors who retain their independence from hospitals. That's somewhat of a challenge, says Lloyd, but he also adds "just because physicians here are not rushing to employment does not mean they're not rushing to engagement."

Proof of physician engagement, says Lloyd, is in the numbers. More than 200 independent, clinically integrated primary care physicians signed on to Memorial Hermann's PCMH created just a year ago, Advanced Primary Care Practices.

"That's an informal way of sort of getting a litmus test on whether or not we are doing the right thing and whether or not physicians want to be engaged and involved, and whether or not they want to be involved in partnership with a hospital system and an organized physician network," says Lloyd.

Moving closer to try to serve patients where they live isn't new. And it isn't just for large, well-financed, and well-known health systems.

Creating new service lines
Winona (Minn.) Health is a nonprofit system with a 60-staffed-bed community hospital, the only hospital in the small town of about 30,000. Leaders there, too, are making plans to meet patients with care closer to home.

One challenge that the organization faces, says Michael Allen, chief financial officer, is that it can't "cherry-pick" the commercial paying customers in the suburbs. "We have to take the entire community as they come."

And despite being the only hospital in town, the Mayo Clinic in Rochester and Gundersen Lutheran Health System in La Crosse are both within driving distance. And all three systems are competing for primary care physicians.